CCE-CE-076

CASE INFORMATION

Case ID: CCE-DERM-012
Case Name: Sarah Thompson
Age: 34
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: S18 – Other Skin Injury

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Establishes rapport and engages the patient
1.2 Explores the patient’s concerns, ideas, and expectations
1.3 Provides clear and structured explanations about wound care and healing
2. Clinical Information Gathering and Interpretation2.1 Takes a structured history, including mechanism of injury, wound characteristics, and risk factors for delayed healing
2.2 Conducts a wound assessment, identifying signs of infection or complications
3. Diagnosis, Decision-Making and Reasoning3.1 Differentiates between simple and complex wounds
3.2 Identifies when further investigations (e.g., wound swab, imaging, tetanus status review) are required
4. Clinical Management and Therapeutic Reasoning4.1 Provides an evidence-based treatment plan, including wound cleaning, dressing selection, and infection prevention
4.2 Advises on pain management, follow-up, and when to seek further care
5. Preventive and Population Health5.1 Assesses tetanus immunisation status
5.2 Provides education on wound care and infection prevention
6. Professionalism6.1 Demonstrates empathy and a patient-centred approach
7. General Practice Systems and Regulatory Requirements7.1 Documents wound assessment and management plan appropriately
8. Procedural Skills8.1 Demonstrates appropriate wound cleaning and dressing techniques
8.2 Identifies when sutures, glue, or steri-strips may be required
9. Managing Uncertainty9.1 Recognises when to monitor, investigate further, or refer for specialist wound care
10. Identifying and Managing the Patient with Significant Illness10.1 Identifies and manages complex wounds requiring escalation of care (e.g., deep tissue involvement, infection, foreign body)

CASE FEATURES

  • Concerned about infection and long-term scarring
  • Superficial laceration on forearm from a kitchen knife injury
  • Mild bleeding at the time, now healing but concerns about redness and pain
  • No known tetanus vaccination status

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face to face.

A patient record summary is provided for your information.

Perform the following tasks:

  1. Take an appropriate history.
  2. Outline the differential diagnosis and key investigations required.
  3. Address the patient’s concerns.
  4. Develop a safe and patient-centred management plan.

SCENARIO

Sarah Thompson, a 34-year-old administrative assistant, presents with a superficial laceration on her right forearm, sustained three days ago while cutting vegetables in the kitchen.

Her symptoms include:

  • Mild pain, redness, and slight swelling around the wound.
  • No pus or fever, but she is concerned about possible infection.
  • Cleaned the wound initially with water and soap but has not changed the dressing since the first day.
  • Uncertain about her last tetanus vaccine.

PATIENT RECORD SUMMARY

Patient Details

Name: Sarah Thompson
Age: 34
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • No known drug allergies

Medications

  • None regularly

Past History

  • No known chronic illnesses

Social History

  • Works in an office, minimal manual labour
  • Non-smoker, occasional alcohol use

Family History

  • No family history of diabetes or delayed wound healing conditions

Vaccination and Preventative Activities

  • Uncertain of last tetanus vaccine (likely >10 years ago)

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

SCRIPT FOR ROLE-PLAYER

Opening Line

“Doctor, I cut my arm a few days ago, and I think it might be getting infected.”

General Information

Sarah Thompson is a 34-year-old administrative assistant who presents with a superficial laceration on her right forearm, sustained three days ago while chopping vegetables in the kitchen.

She is mildly anxious about the wound, concerned about infection, scarring, and whether she needs a tetanus shot.

  • Accidentally cut herself with a kitchen knife while slicing carrots.
  • Mild bleeding at the time, which she stopped with pressure and a paper towel.
  • Rinsed it under water and applied a bandage, but hasn’t been changing it daily.

Specific Information

(To be revealed only when asked)

Background Information

  • Noticed some redness and slight swelling around the wound yesterday.
  • Pain is mild, but the area is tender when touched.
  • No pus, fever, or spreading redness.

Wound Details

(Sarah will describe the following if asked about the injury.)

  • Superficial laceration, about 2cm long, clean cut, no jagged edges.
  • No deep tissue involvement, no visible muscle, tendon, or bone.
  • Mild redness around the wound, but no pus or discharge.
  • No increasing pain or spreading swelling.

Self-Management Attempts

(Sarah will explain what she has done so far if asked.)

  • Cleaned the wound with water and soap initially.
  • Applied a basic adhesive bandage, but only changed it once.
  • Hasn’t used antiseptic cream or other wound dressings.
  • Has been avoiding getting it wet but hasn’t actively monitored healing.

Pain and Functional Impact

(Sarah will describe how the injury is affecting her if asked.)

  • Mild discomfort when pressing on the wound or moving her wrist.
  • Not interfering with work, but she’s conscious of it.
  • No numbness, tingling, or movement restrictions.

Concerns About Infection and Healing

(Sarah will ask about these issues when prompted.)

  • “How do I know if this is infected?”
  • “What should I do to help it heal faster?”
  • “Do I need antibiotics?”
  • “What should I put on it to prevent scarring?”
  • “How long will this take to heal?”

Emotional Cues

Sarah is mildly anxious but not in distress.

  • She is concerned about infection and scarring.
  • She is unsure about proper wound care and looking for clear guidance.
  • If the doctor is vague or dismissive, she may insist on antibiotics or further testing.
  • She may become more worried if the candidate mentions infection risks without reassuring her about her current wound status.

Questions for the Candidate

Sarah may ask some or all of the following:

  1. “Does this look infected?”
  2. “Do I need antibiotics for this?”
  3. “Should I put anything on it to prevent scarring?”
  4. “Do I need a tetanus shot?”
  5. “How long will this take to heal?”
  6. “Should I get it checked again if it doesn’t improve?”

Expected Reactions Based on Candidate Performance

If the candidate provides a clear explanation and structured plan:

  • Sarah will feel reassured and follow the wound care advice.
  • She may say: “Okay, I’ll clean it properly and change the dressing every day.”

If the candidate is vague or dismissive:

  • Sarah may insist on antibiotics or unnecessary interventions.
  • She may feel uncertain about proper wound care.
  • She may say: “So, should I just wait and see? What if it gets worse?”

Key Takeaways for the Candidate

  • Take a structured history, including mechanism of injury, wound assessment, and risk factors for poor healing.
  • Provide clear wound care instructions, including daily cleaning, dressing changes, and signs of infection.
  • Discuss the role of tetanus vaccination and offer a booster if required.
  • Educate on normal wound healing timeframes and when to return for review.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including mechanism of injury, wound characteristics, infection risk, and tetanus status.

The competent candidate should:

  • Obtain a detailed history, including:
    • Mechanism of injury (kitchen knife laceration, no deep tissue involvement).
    • Wound care history (initial cleaning, dressing use, frequency of dressing changes).
    • Symptoms (pain, redness, swelling, no pus, no systemic signs).
    • Infection risk factors (wound cleanliness, comorbidities like diabetes, immune status).
    • Tetanus immunisation status (uncertain, likely >10 years ago).
  • Screen for red flags, including:
    • Increasing pain, spreading redness, warmth, or pus (suggestive of cellulitis).
    • Fever or malaise (systemic infection risk).
    • Loss of sensation, movement, or severe swelling (deeper tissue involvement).

Task 2: Conduct a clinical wound assessment to determine infection risk, healing status, and need for further management.

The competent candidate should:

  • Assess wound characteristics:
    • Size, depth, presence of foreign bodies, signs of infection.
    • Look for delayed healing or high-risk wound features (e.g., jagged edges, poor circulation).
  • Determine whether investigations are required:
    • Wound swab if purulent discharge or severe infection suspected.
    • Blood tests if systemic infection signs present.
  • Assess need for tetanus prophylaxis:
    • Offer tetanus booster if last vaccine was >10 years ago.

Task 3: Provide a treatment plan, including wound care, infection prevention, pain relief, and follow-up advice.

The competent candidate should:

  • Wound care:
    • Clean the wound with normal saline or antiseptic.
    • Apply an appropriate dressing (e.g., non-adherent pad, hydrocolloid if moist wound healing needed).
    • Educate on daily dressing changes and keeping the wound dry.
  • Infection prevention and management:
    • Monitor for increasing redness, pain, pus, warmth, or systemic symptoms.
    • Avoid unnecessary antibiotics unless infection is clinically present.
  • Pain relief:
    • Paracetamol or NSAIDs if needed.
  • Tetanus prophylaxis:
    • Offer booster if indicated.
  • Follow-up:
    • Review in 2-3 days if concerns about infection.
    • Return earlier if worsening symptoms.

Task 4: Educate the patient on healing expectations, infection signs, and when to seek further medical attention.

The competent candidate should:

  • Explain normal wound healing:
    • “Most minor wounds heal within 1-2 weeks with proper care.”
  • Educate on infection warning signs:
    • “If the redness spreads, pain worsens, or you develop fever, return immediately.”
  • Discuss scar prevention:
    • Apply silicone gel or vitamin E after healing.
  • Safety-netting:
    • “If the wound does not improve or worsens, return for reassessment.”

SUMMARY OF A COMPETENT ANSWER

  • Takes a structured history, identifying mechanism of injury, wound care, and infection risks.
  • Conducts a thorough wound assessment, determining infection risk and healing status.
  • Provides clear wound management advice, including dressing, cleaning, and pain relief.
  • Assesses tetanus immunisation status and offers prophylaxis if needed.
  • Educates on healing expectations and signs of infection.

PITFALLS

  • Failing to assess for infection risk, missing signs of cellulitis or systemic infection.
  • Overprescribing antibiotics when no clear infection is present.
  • Not addressing tetanus immunisation, missing an opportunity for prevention.
  • Providing vague wound care advice, leading to poor healing or infection risk.
  • Not offering appropriate follow-up, missing potential complications.

REFERENCES

MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, expectations of healthcare and the full impact of their illness experience on their lives.
1.3 Provides clear and structured explanations about wound care and healing.

2. Clinical Information Gathering and Interpretation

2.1 Takes a structured history, including mechanism of injury, wound characteristics, and risk factors for delayed healing.
2.2 Conducts a wound assessment, identifying signs of infection or complications.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between simple and complex wounds.
3.2 Identifies when further investigations (e.g., wound swab, imaging, tetanus status review) are required.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides an evidence-based treatment plan, including wound cleaning, dressing selection, and infection prevention.
4.2 Advises on pain management, follow-up, and when to seek further care.

5. Preventive and Population Health

5.1 Assesses tetanus immunisation status.
5.2 Provides education on wound care and infection prevention.

6. Professionalism

6.1 Demonstrates empathy and a patient-centred approach.

7. General Practice Systems and Regulatory Requirements

7.1 Documents wound assessment and management plan appropriately.

8. Procedural Skills

8.1 Demonstrates appropriate wound cleaning and dressing techniques.
8.2 Identifies when sutures, glue, or steri-strips may be required.

9. Managing Uncertainty

9.1 Recognises when to monitor, investigate further, or refer for specialist wound care.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies and manages complex wounds requiring escalation of care (e.g., deep tissue involvement, infection, foreign body).

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD